Genetic prediction of renal transplant outcome.
OBJECTIVE
In the present study, we reviewed recent publications regarding potential genetic predictors of transplant outcome, including acute rejection, metabolism of immunosuppressive medications, long-term transplant outcome, and posttransplant complications.


RESULTS
Recent studies are based on the candidate gene analysis; specifically, cytokine genes and innate immune response molecules present popular targets for studies of acute rejection and long-term outcome. Pharmacogenomic studies are mostly focused on the genes of drug targets or the corresponding enzymes metabolizing the drug. Posttransplant complications (i.e. infections, diabetes, and malignancies) are associated with a variety of genes of different pathways. Most of the studies are based on just recipient, but not donor, genotype analysis. Positive results are balanced by reports of no association when evaluating the same genetic polymorphisms. Some of the reports might be affected by insufficient study design, including small sample size, lack of adjustment for potential confounders, and multiple comparisons.


CONCLUSIONS
The field remains controversial because of differences in populations, study design, and statistical methods. Studies are based on candidate gene analysis; however, genome-wide association studies are lacking. Future research should be directed at better designed studies, larger sample size, evaluating both recipients and donors, and implementation of genome-wide association studies.
Goldfarb-Rumyantzev
Alexander S
AS
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. agoldfar@bidmc.harvard.edu
Naiman
Natalie
N
D000208:Acute Disease; D035843:Biomedical Research; D016207:Cytokines / Q000235:genetics; D015971:Gene Expression Regulation, Enzymologic; D006084:Graft Rejection / Q000235:genetics* / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000235:genetics* / Q000276:immunology; D006801:Humans; D007113:Immunity, Innate / Q000235:genetics; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome
D016207:Cytokines; D007166:Immunosuppressive Agents